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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374604233
Report Date: 11/28/2023
Date Signed: 11/28/2023 03:06:57 PM

Document Has Been Signed on 11/28/2023 03:06 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SAN DIEGO RO, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:TARLETON HOUSEFACILITY NUMBER:
374604233
ADMINISTRATOR:CESIAH SERRANOFACILITY TYPE:
735
ADDRESS:1650 TARLETON STTELEPHONE:
(619) 323-0804
CITY:SPRING VALLEYSTATE: CAZIP CODE:
91977
CAPACITY: 6CENSUS: 4DATE:
11/28/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Angelica Marin, Caregiver &
Cesiah Serrano, Administrator		TIME COMPLETED:
03:17 PM
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Licensing Program Analyst (LPA) Tiffany Holmes conducted an unannounced Case Management visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Administrator Cesiah Serrano during the visit.

Today's visit was in response to an email in which LPA Holmes received on 11/27/2023 regarding issues at the facility. The administrator will possibly be providing 60 day notices to the clients, San Diego Regional Center (SDRC) and to CCL.

During today’s visit, LPA performed a brief facility tour and welfare check verifying that the clients were safe. No deficiencies observed or cited today during the visit.

An exit interview was conducted with Serrano, to whom a copy of this report, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.

SUPERVISORS NAME: Denise Powell
LICENSING EVALUATOR NAME: Tiffany Holmes
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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